CORONAVIRUS (COVID-19)
(updated 06/03/2022)
​Please go to the end of this page for information regarding COVID-19 vaccine and booster and check back as needed for updates

We now have EVUSHELD available (ask your physician about it; more information at the end of this page)

If you are sick, please stay home. 

We require all staff, patients and visitors to wear a mask that covers the mouth and nose. Masks with valves are NOT allowed since they do not prevent the transmission of virus.

We request that for your appointment, you come alone unless assistance is required for translation, you are unable to manage walking by yourself, or have issues with your memory/comprehension.  This precaution is to limit exposure to the visitors, other patients and staff.  If a driver is necessary, we request that they wait outside or in the waiting room.  We hope you understand that we are trying to limit the spread of COVID-19 in any way possible. 
 
Our current guidelines are to continue all the medications prescribed to you by our office including prednisone, biologic therapy, and all DMARD therapy.  However, if you have been exposed to someone who has tested positive for COVID-19 or is undergoing testing for COVID-19, hold biologic therapy/targeted DMARD therapy for 2 weeks (except you may continue Actemra and Kevzara). If you remain symptom free (with no fevers, chills, cough, or shortness or breath), you may resume your biologic therapy. 

​If you have any signs/symptoms of coronavirus such as fever, cough, shortness of breath, loss of smell/taste, we ask that you call your family doctor’s office for guidance regarding testing and treatment for coronavirus - we recommend monoclonal antibody treatment for all immunocompromised patients either prophylactically after exposure (prior to symptoms) or with symptoms as soon as possible.  Continue your Hydroxychloroquine/Chloroquine.  Stop Methotrexate, Leflunomide, Azathioprine, Sulfasalazine, Cellcept.  If you are on steroids (prednisone, methylprednisolone), please call our office for directions.  Steroids should never be stopped abruptly.  Stop targeted DMARD/biologic therapy (Remicade, Humira, Enbrel, Simponi, Cimzia, Orencia, Xeljanz, Olumiant, Rinvoq, Rituxan, Benlysta, Cosentyx, Taltz, Stelara, Tremfya) just as you would hold these medications for any other illness.  However, if you are on Actemra or Kevzara, please call our office for further directions regarding their continued use.
 
If you have a fever, avoid taking lNSAIDs (Ibuprofen, Aleve meloxicam etc).  You may take Tylenol for a fever.  If you already take an NSAID regularly, you may continue to take it as long as you do not have severe respiratory symptoms. 

PER CDC update on 12/27/2021Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation for the public. People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.  Immunocompromised patients should self-isolate for 10 days since their ability to neutralize the virus may take longer. 
Additionally, CDC is updating the recommended quarantine period for anyone in the general public who is exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure.  For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.


All the currently available vaccines in the US - Pfizer/BioNTech (mRNA vaccine), Moderna (mRNA vaccine) and Johnson and Johnson are not live vaccines.  
The American College of Rheumatology released guidelines (not rules) for the COVID-19 vaccine in patients with rheumatic illness:

EVERYONE SHOULD GET THE VACCINE (prefer mRNA vaccine)
  • No modifications to either immunomodulatory therapy or vaccination timing with the primary vaccine series
    • Hydroxychloroquine (Plaquenil); IVIG; glucocorticoids (steroids), prednisone <20mg/day
    • Sulfasalazine; Leflunomide (Arava); Azathioprine (Imuran); oral Cyclophosphamide (Cytoxan);
    • TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); IL-6R (Actemra, Kevzara); IL-1 (Anakinra, Kineret); IL-17 (Cosentyx, Taltz); IL-12/23 (Stelara); IL-23 (Tremfya); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin)
  • HOLD Therapy (only if your disease is well controlled - you have not used higher dose prednisone for at least one month; please check with your rheumatologist if you are uncertain about your disease control) 
    • Methotrexate (MTX): Hold MTX one dose after each vaccine dose or on the day of the vaccine if your MTX happens to be on the same day as the vaccine; if you receive a single dose vaccine, hold MTX for 2 doses after the vaccine
    • Cellcept (mycophenolate): Hold for one week after each dose of vaccine
    • JAK Inhibitor (Xeljanz, Rinvoq, Olumiant): Hold JAKi for 1 week after each vaccine dose
    • Abatacept (Orencia): Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose
      • IV ABA (Orencia): Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose
    • Rituximab (Rituxan): Schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay Rituxan 2-4 weeks after 2nd vaccine dose, if disease activity allows
    • IV Cyclophosphamide (Cytoxan, CYC): Time CYC infusion one week after each vaccine dose, when feasible


If you have an autoimmune inflammatory disease treated with any medications listed below (other than Hydroxychloroquine)
 
YOU ARE                                   IF YOU RECEIVED                              IF YOU RECEIVED                       IF YOU RECEIVED
ELIGIBLE                                  PFIZER-BIONTECH                            MODERNA                                  JOHNSON&JOHNSON’S
                                                                                                                                                                   JANSSEN
 
Additional                                 given 28 days after                            full dose given 28 days                No additional primary shot      Primary Shot                            2nd shot (this 3rd                            after 2nd shot (this 3rd                  recommended at this time
(3rd dose if Pfizer                    shot is still considered                       shot is still considered                                                                        or Moderna)                            part of the primary                             part of the primary                                                                           
strongly recommended             series)                                              series)
 
 
Booster dose                           May get either mRNA                          May get either mRNA                       May get either mRNA        
(4th dose if primary              COVID-19 vaccine 4 months               COVID-19 vaccine 4 months              COVID-19 vaccine 2 months  
series was mRNA                 after the primary 3 shot series             after the primary 3 shot series          after the primary shot and a 3rd 
vaccine)                                                                                                                                             4 months later
                                                               
 
  • No antibody testing is recommended after any COVID-19 vaccine or COVID infection to assess response to vaccine or need for booster dose​
  • You should get the 3rd dose (includes full dose of Moderna) if were are on any of the following medications with the primary vaccine series – Methotrexate, Leflunomide, Sulfasalazine, Azathioprine, Cellcept/Mycophenolate, Cytoxan, Orencia/Abatacept, JAK inhibitors (Xeljanz, Olumiant, Rinvoq), TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); IL-6R (Actemra, Kevzara); IL-1 (Anakinra, Kineret); IL-17 (Cosentyx, Taltz); IL-12/23 (Stelara); IL-23 (Tremfya); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin); Ilaris
  • If your rheumatic disease is well controlled, please hold these RA medications for 1-2 weeks after the booster dose (Methotrexate, Leflunomide, Sulfasalazine, Azathioprine, Cellcept/Mycophenolate, Orencia/Abatacept, JAK inhibitors (Xeljanz, Olumiant, Rinvoq), TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin))​
  • If you are on Rituxan infusions, please call the office so we may advise you on the timing of the vaccine and discuss Evusheld (antibody injections)
  • If you are on prednisone on a daily basis, please call the office for directions. If you take prednisone as needed, please avoid taking prednisone for at least 2 weeks after the vaccine.
  • If your rheumatic disease is not well controlled, please call the office BEFORE you stop your medications
CDC also strongly recommends:
  • Wearing a mask
  • Staying 6 feet apart from those they don’t live with
  • Avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider
  • Close contacts of immunocompromised people are strongly encouraged to be vaccinated against COVID-19



EVUSHELD:
The U.S. Food and Drug Administration has issued an EUA for the emergency use of the unapproved product EVUSHELD (tixagevimab co-packaged with cilgavimab), for the pre-exposure prophylaxis of COVID-19 in adults and pediatric individuals (12 years of age and older weighing at least 40 kg):
 Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARSCoV-2 and
 Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination
or
 For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).

After COVID-19 vaccine, wait 2 weeks prior to getting EVUSHELD injection

You may receive the COVID-19 booster dose and flu shot on the same day

Here is a link to more information about vaccines against COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html

https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines

https://www.nejm.org/covid-vaccine/faq

We ask that you follow the guidelines suggested by CDC and please review the following website for additional up to date information.
www.coronavirus.gov​